The Influence of Neglect on Internalizing Problems among Children: Focusing on the Mediating Effects of the Cumulative Risk Factors

Protecting worker and public health involves an understanding of multiple determinants, including exposures to biological, chemical, or physical agents or stressors in combination with other determinants including type of employment, health status, and individual behaviors. This has been illustrated during the COVID-19 pandemic by increased exposure and health risks for essential workers and those with pre-existing conditions, and mask-wearing behavior. Health risk assessment practices for environmental and occupational health typically do not incorporate multiple stressors in combination with personal risk factors. While conceptual developments in cumulative risk assessment to inform a more holistic approach to these real-life conditions have progressed, gaps remain, and practical methods and applications are rare. This scoping review characterizes existing evidence of combined stressor exposures and personal factors and risk to foster methods for occupational cumulative risk assessment. The review found examples from many workplaces, such as manufacturing, offices, and health care; exposures to chemical, physical, and psychosocial stressors combined with modifiable and unmodifiable determinants of health; and outcomes including respiratory function and disease, cancers, cardio-metabolic diseases, and hearing loss, as well as increased fertility, menstrual dysfunction and worsened mental health. To protect workers, workplace exposures and modifiable and unmodifiable characteristics should be considered in risk assessment and management. Data on combination exposures can improve assessments and risk estimates and inform protective exposure limits and management strategies.

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Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect

Annals of Intensive Care ◽

10.1186/s13613-021-00873-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anastasia Saade ◽

Giulia Moratelli ◽

Guillaume Dumas ◽

Asma Mabrouki ◽

Jean-Jacques Tudesq ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

Cumulative Risk ◽

Incidence Density ◽

Hospital Acquired Infections ◽

Underlying Malignancy ◽

Single Center Study ◽

High Prevalence ◽

Immune Defect ◽

Hospital Acquired

Abstract Background Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. Methods Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. Results We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18–35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8–13.9]. Incidence density of hospital-acquired infections was 125 [91–200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient’s severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20–53] vs. 12% [4–20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18–52] vs. 13% [1–25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. Conclusions In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.

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Risk Factors for Suicide Attempts Among African American Women Experiencing Recent Intimate Partner Violence

Violence and Victims ◽

10.1891/vivi.17.3.283.33658 ◽

2002 ◽

Vol 17 (3) ◽

pp. 283-295 ◽

Cited By ~ 60

Author(s):

Martie P. Thompson ◽

Nadine J. Kaslow ◽

J. B. Kingree

Keyword(s):

Risk Factors ◽

African American ◽

Suicide Attempt ◽

African American Women ◽

Suicide Attempts ◽

Risk Model ◽

Cumulative Risk ◽

American Women ◽

Cumulative Risk Model ◽

Risk Factors For Suicide

The purposes of this study were to identify risk factors for suicide attempts among 200 African American abused women (100 attempters, 100 nonattempters) and to test a cumulative risk model to determine if a woman’s likelihood of making a suicide attempt increased as the number of risk factors increased. Results revealed that attempters were significantly more likely than nonattempters to report high levels of depressive symptoms, hopelessness, drug abuse, and childhood abuse and neglect. Results from the cumulative risk model revealed a linear association between the number of risk factors and the odds of making a suicide attempt. Compared to women with no risk factors, women with two risk factors, women with three risk factors, and women with four to five risk factors were 10, 25, and 107 times, respectively, more likely to attempt suicide. The identification of risk variables highlights the importance of designing interventions to address these factors in order to reduce the risk of suicidal behavior in abused, African American women.

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The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up

PEDIATRICS ◽

10.1542/peds.98.2.216 ◽

1996 ◽

Vol 98 (2) ◽

pp. 216-225 ◽

Cited By ~ 2

Author(s):

Shlomo Shinnar ◽

Anne T. Berg ◽

Solomon L. Moshe ◽

Christine O'Dell ◽

Marta Alemany ◽

...

Keyword(s):

Risk Factors ◽

Age Of Onset ◽

Multivariable Analysis ◽

Cumulative Risk ◽

Febrile Seizures ◽

Recurrence Risk ◽

Early Recurrence ◽

Seizure Recurrence ◽

Unprovoked Seizure ◽

History Of

Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood. Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure. Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence. Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.

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Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approach

Journal of Speech Language and Hearing Research ◽

10.1044/2021_jslhr-21-00162 ◽

2021 ◽

pp. 1-26

Author(s):

Cara M. Singer ◽

Sango Otieno ◽

Soo-Eun Chang ◽

Robin M. Jones

Keyword(s):

Risk Factors ◽

Predictive Validity ◽

Predictive Factors ◽

Language Skills ◽

Speech Sound ◽

Cumulative Risk ◽

Standard Score ◽

Persistent Developmental Stuttering ◽

Risk Approach ◽

Developmental Stuttering

Purpose: The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering. Method: We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated. Results: Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased. Conclusions: Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

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ADHD and ODD Dimensions: Time Varying Prediction of Internalizing Problems from Childhood to Adolescence

Journal of Attention Disorders ◽

10.1177/10870547211050947 ◽

2021 ◽

pp. 108705472110509

Author(s):

Felix K. So ◽

Denise Chavira ◽

Steve S. Lee

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Oppositional Defiant Disorder ◽

Internalizing Problems ◽

Ethnically Diverse ◽

Time Varying ◽

Childhood Adhd ◽

Oppositional Defiant ◽

Inattention And Hyperactivity ◽

Odd Dimensions

Objective Although childhood ADHD is a risk factor for internalizing problems, it consists of separable inattention and hyperactivity dimensions that differentially predict outcomes. Oppositional defiant disorder also consists of separable dimensions (i.e., irritable, oppositional), co-occurs with ADHD, and predicts internalizing outcomes. To discern independent associations with internalizing problems, dimensions must be considered simultaneously. Methods Controlling for age, sex, and race, we tested inattention, hyperactivity, irritability, and oppositionality as time-varying predictors of 6 to 7-year prospective change in parent- and teacher-rated internalizing problems in 230 ethnically- diverse (50% Caucasian) 5 to 10 year old youth ( M = 7.4 years, 68% male) with ( n = 120) and without ADHD ( n = 110). Results Escalating inattention and irritability, but not hyperactivity and oppositionality, uniquely predicted internalizing problems. Conclusion These findings suggest that inattention and irritability are unique risk factors for later internalizing problems. These dimensions may catalyze internalizing problems across development and constitute important intervention targets.

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Cumulative Risk and Immigrant Youth’s Health and Educational Achievement: Mediating Effects of Inter- and Intra-Familial Social Capital

Youth & Society ◽

10.1177/0044118x17717501 ◽

2017 ◽

Vol 51 (6) ◽

pp. 793-813

Author(s):

Jing Zhang ◽

Jyoti Savla ◽

Hsiu-Lan Cheng

Keyword(s):

Social Capital ◽

Young Adulthood ◽

Family Cohesion ◽

Educational Achievement ◽

Cumulative Risk ◽

Immigrant Parents ◽

School Involvement ◽

Mediating Effects ◽

Parental School Involvement ◽

Using Data

Using data from Children of Immigrants Longitudinal Study, this study examined the longitudinal effects of cumulative risk of immigrant parents on immigrant youth’s health and educational achievement in young adulthood. The mediating effects of intra- (i.e., family cohesion) and inter-familial (i.e., parental school involvement) social capital were also examined. The findings showed that cumulative risk was negatively associated with youth’s health and educational achievement in young adulthood. In addition, parental school involvement mediated the association between cumulative risk and youth’s health and educational achievement. The findings suggest that inter-familial social connections may be a critical intervention target for immigrant youth preventive interventions.

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